Continued Increase of Axial Length and Its Risk Factors in Adults With High Myopia

Abstract

IMPORTANCEPathologic myopia due to an excessive increase of axial length is associated with severe visual impairments. Systematic analyses to determine the rate of and the risk factors associated with the axial elongation in adults with high myopia based on long-term follow-up of a large population are needed.OBJECTIVE To determine the risk factors associated with axial elongation in adults with high myopia.DESIGN, SETTING, AND PARTICIPANTS This cohort study used the medical records of 43 201 patient visits in a single-hospital database that were collected from January 3, 2011, to December 28, 2018. A total of 15 745 medical records with the patients' sex, best-corrected visual acuity (BCVA), axial length, type of myopic maculopathy, and the presence or absence of choroidal neovascularization (CNV) were reviewed. Data were analyzed from April 3, 2019, to August 5, 2020.MAIN OUTCOMES AND MEASURES Changes in the axial length at each examination were calculated. The significance of the associations between the annual increase of the axial length and age, sex, baseline axial length, types of myopic maculopathy, and a history of CNV was determined. Generalized linear mixed models were used to evaluate the strength of the risk factors associated with an increase of the axial length in high myopia.RESULTS Among 1877 patients with 9161 visits included in the analysis, the mean (SD) age was 62.10 (12.92) years, and 1357 (72.30%) were women. The mean (SD) axial length was 29.66 (2.20) mm with a mean (SD) growth rate of 0.05 (0.24) mm/y. Among the 9161 visits, 7096 eyes (77.46%) had myopic maculopathy and 2477 eyes (27.04%) had CNV. The odds ratio for inducing a severe elongation of the axial length was 1.46 (95% CI, 1.38-1.55) for female sex, 0.44 (95% CI, 0.35-0.56) to 0.63 (95% CI, 13 0.50-0.78) for older than 40 years, 1.33 (95% CI, 1.15-1.54) for BCVA of less than 20/400, 1.67 (95% CI, 1.54-1.81) to 2.67 (95% CI, 2.46-2.88) for baseline axial length of 28.15 mm or greater, 1.06 (95% CI, 0.96-1.17) to 1.39 (95% CI, 1.24-1.55) for the presence of maculopathy, and 1.37 (95% CI, 1.29-1.47) for prior CNV.CONCLUSIONS AND RELEVANCE This cohort study found continuing axial elongation in adults with high myopia. The risk factors for elongation do not appear to be modifiable, so prevention of myopia may be the best approach to reduce the incidence of pathologic myopia and its complications in the future.

Safety and tolerability of intravitreal cetuximab in young and adult rabbits

“…Correspondingly, the physiologic eye growth in the young rabbit group was not significantly influenced by the intravitreal cetuximab application. It is in contrast to studies with young guinea pigs in which the physiological eye growth and the lens-induced myopic enlargement of the globe were reduced when an EGF receptor antibody specific for guinea pig EGF receptors was intraocularly injected 4 . It was also in contrast to findings obtained in young nonhuman primates in which intravitreally amphiregulin antibody as another EGF antibody was associated with a reduction of the physiological eye growth (own data).…”

“…The concentration of cetuximab as an EGF receptor antibody used in the rabbits of this study (500 µg cetuximab/2100 mm 3 rabbit ocular volume or 0.24 ug cetuximab/mm 3 rabbit ocular volume) was higher than the intraocular concentration of an EGF receptor antibody applied in a recent study, in which guinea pigs with a globe diameter of 8 mm and a globe volume of 268 mm 3 received a dose of 20 µg of the EGF receptor antibody (20 µg EGF receptor antibody/268 mm 3 or 0.07 µg EGF receptor antibody/mm 3 ) 4 . As in the present study, the study on guinea pigs did not reveal any sign of intraocular toxicity of the intraocularly and repeatedly applied EGF receptor antibody.…”

“…In the case of an overshooting of the process, axial myopia results. While in moderately myopic individuals, axial myopization usually stops in the third decennium, recent studies have revealed that in adult highly myopic patients, axial elongation can continue and constitute a major risk factor for the progression of myopic macular degeneration 1 – 4 . Histomorphometric, immunohistochemical, experimental and clinical studies have suggested that epidermal growth factor (EGF) may be involved in the process of axial elongation 5 – 8 .…”

“…As a corollary, intravitreal application of antibodies against EGF and EGF family members such as amphiregulin and neuregulin-1, or the intraocular injection of antibodies against the EGF receptor was associated with a reduction in axial elongation 6 – 8 . These observations led to the question whether the intraocular application of an antibody to the EGF receptor could clinically be helpful to prevent further axial elongation in adult patients with pathologic myopia 1 – 4 . The notion of EGF being involved in the process of axial elongation has been supported by a recent small case series study in which the intraocular concentration of EGF was higher in the eyes of highly myopic patients than in non-highly myopic eyes 9 .…”

Association of Axial Length and Myopia Degree: A Retrospective Study

“…from Du et al stated continuing axial elongation in adults with high Myopia. 10 This study aims to determine the association between axial length and myopia degree in myopia patients at Dr. Mohammad Hoesin Palembang.…”